a musing - about homebirth - and moving on!

In the MLBU there are 3 post-birth beds to get to know your baby in peace.
I think Anne can tell you that the main ward isn't like that at all.

I'll do a brief history, basically the Rosie (the maternity hospital in
Cambridge) used to have two combined postnatal and antenatal wards, Lady
Mary and Christine, about 2002, Christine was closed due to staffing
problems, from time to time, a bay of it was used as an extension of Lady
Mary, as Lady Mary was too small for for the need, eventually 2 bays of
Christine were taken over permenantly as Lady Mary Annex, with a 3rd
potentially available, this leaves Lady Mary with 2 5 bed bays, 2 6 bed
bays, 4 private rooms and 2 6 bed bays on the annex, where the antenatal
cases are usually sent, so it's a very busy place! The MLBU took over the
private rooms and 5 bed bays from the old Christine ward and some
remodelling has taken place, it's unusual by British and world standards,
because it's a midwife led unit in the same building as a consultant led
unit, issues from transfer vanish, unfortunately, it's not usually open 100%
of the time due to staffing issues.

Lucy, the difference in a longer labour, is not just change of midwifes, but
often spending large periods of time without a midwife at all, low risk
women on consultant led units will be shared between remaining staff after
high risk women are covered, which can end up being as bad as 1 midwife to 7
women, the plan is usually for 1 to 3.


All in all I think I would like to have a go at a home birth but with the
anti-b's for Group Strep B I can't do that. I do know that you don't have
to have them but it's only taken the experience of one mum's baby who died
because she did'n't have it and they didn't treat the baby after for me to
know I'm not interested in taking that risk, as minimal as it may be.

Ask again, I've definitely known people in Cambridge get clearance for this
prior to the existance of the midwife led unit and they may now be using the
existance of it to say oh, it's no issue, just come to the midwife led unit,
it's home from home, fast discharge, blah blah blah. If you want something,
always ask, after all, if it remains that the MLBU is not open 100% of the
time, you could end up upstairs, alone and on a monitor, because you are not
high risk.

Anne

I'm wondering whether if you provided the exact same care at hospital as
you did at home, then you'd make it even safer, the doctors would be
safely tucked away in the background, but available if one of the rare
occurances of a crash section that wouldn't have allowed time to transfer
was needed,
The only times I saw a doctor for either of my births was for #1 putting
the epidural in, and for both the well baby check. I thought doctors did
generally stay in the background. Certainly for #2 I was down as high
risk, and consultant led, but still was entirely left with the midwife

clearly, isolated cases are going to get the same care kind of midwifery
care, whether at home or in the hospital, but most places that isn't the
model of what is supposed to happen, it can sometimes be advantageous to be
labelled high risk, you're much more likely to get 1 on 1 midwifery care,
problem is, you are also much more likely to get something like continuous
monitoring, regular VEs and so on.

What happens to one person isn't really the point, hospital birth worked
fine for you, probably for a mixture of reasons, I seem to recall your first
labour was longish, so it's possible that it "should" have been augmented,
clearly as you gave birth safely it wasn't necessary, but was the fact it
didn't happen, because of a system that didn't even suggest it, a midwife
that went against local protocol, a doctor that was busy and didn't noticed
that the women in room x still hadn't given birth etc. So even with your
presentation of labour (if I've remembered correctly), chances are that the
way things normally work in hospital, some proportion would have been
augmented, some sectioned because it was still too slow, or baby was
distressed by the augmentation, plus a few assisted deliveries etc. What I'm
digging around to figure out, is not to change the location the women with
your presentation gives birth, but to work out how the women with your
presentation has the experience you had, that they are able to labour at
their own speed, that they can get the epidural if needed, once other
options are exhausted and that they've had the full chance to explore other
options, the chance to be mobile, or to be still, the chance to get as
comfortable as possible, on or off the bed, the chance to try water and so
on. Realistically, how many women do get to have the experience you have in
hospital, I suspect it's a scarily small number.

Anne

Welches wrote:
"Ericka Kammerer" wrote in message
. ..
lucy-lu wrote:
"Anne Rogers" wrote in message
...
Yeah... It was a passing thought really. All the positives I had from a
hosp birth turned me off a home birth.
I think that's an odd way to phrase it ;-) I can see why
a positive hospital birth would turn you *on* to a hospital birth,
but not sure why it would change your perception of a home birth.

I just don't really understand the difference between going to a birth
center and a delivery ward - obviously I understand there aren't the docs
etc there, but when I had Jessica, I recognised the consult on duty, one
I'd seen earlier in my pg and hated, and so refused to have him there. He
didn't interfere after that. Maybe the problem is that more women need to
take greater control and have more say in their labours. I suspect a lot
that choose to birth outside of a hospital already have this ability, and
therefore that could be a factor in their positive birth experiences?
I'm not sure that's true. There is a very different power
structure in one's home versus in a hospital. Someone who can speak
out in an environment where they are in charge is not necessarily
going to speak out in an environment where they're not running the
show. I think many people choose homebirth so they won't *have*
to fight because they know they're not good at that.

I think what Lucy is saying is that here (the UK) it is generally assumed
that you will go to hospital to have the baby (not so much by the medical
profession, but by general opinion). Someone who decides to have a home
birth will often have a lot of "do you think it's wise" sort of comments. So
(I think) what Lucy is saying is that someone who stays firm and gets a home
birth (particularly for the first birth which is harder to get) is more
likely to stand up generally for themselves wherever they labour.

It's like that in the US too, but I don't think it's
warranted to assume that all people who are able to stand up to
family and friends to have a homebirth are also able to stand up
to doctors and policies while in labor. I think there are two
very different scenarios, and I know plenty of normally assertive
women who felt steamrolled during labor and many women who were
not particularly assertive who chose homebirth precisely so that
they wouldn't have to be so assertive during labor to get what they
wanted.

Correct me if I'm wrong :-)
This reluctance for first home births here, does also mean that you get a
number of people who will tell you that they had a dreadful first birth in
hospital and a lovely second birth at home and put it down to being at home
rather than second births being easier (vast generalisation here) which can
mean that a for lot of home v hospital birth stories people (particularly
the older generation)can be very skeptical, and make comments accordingly.

Sure. I think that's true many places. In the US, the
out of hospital birth rate is under 1 percent (IIRC), so homebirths
of any sort are unusual, and particularly so for first births.

Best wishes,
Ericka

I think there are two
very different scenarios, and I know plenty of normally assertive
women who felt steamrolled during labor and many women who were
not particularly assertive who chose homebirth precisely so that
they wouldn't have to be so assertive during labor to get what they
wanted.

Absolutely! I arranged and defended a homebirth, twice, no problem. My first
turned into a hospital birth due to PROM and IUGR, I was asked about
induction at home, discussed it and agreed with it and was basically very
happy with the birth experience, though wished I'd had more support in
managing contractions, I was just left to myself, I honestly think that
time, that had I had support for that I'd have not needed an epidural. 2nd
time around, I found myself in hospital at the end of pregnancy, I'd made a
birth plan that specifically stated absolutely no induction or augmentation,
yet in a fog of pethidine, induction was repeatedly offered, was booked
without my consent and as doctors kept visiting the moment my husband had
left, ultimately found myself consenting to it. The induction attempt
failed, but I went into labour before anything progressed, I know that the
women that was wheeled into the delivery room, helped onto a bed and
strapped to monitors, was not the women I would have been had I gone into
labour at home, trying not to be too hard on myself, it was a brutal back
labour and I'd already been violently sick in the corridor, but even so, it
was only the things that were very clearly stated in my birth plan that
occured when my husband was present that were stuck to, they were pretty
key, so I'm glad they were, but that's a whole different story to what could
have happened at home - I know that labour could not have happened at home,
my poor physical condition was unsubstainable at home, in reality, I needed
more care than the antenatal ward was equipped for, but I can still look at
that and see how hospital affected my demeanour, my ability to speak up and
so one, whilst also accepting that some part of that was down to my poor
physical condition and the drugs in my system.

Cheers

Anne

"Ericka Kammerer" wrote in message
. ..
lucy-lu wrote:
"Anne Rogers" wrote in message
...

Yeah... It was a passing thought really. All the positives I had from a
hosp birth turned me off a home birth.

I think that's an odd way to phrase it ;-) I can see why
a positive hospital birth would turn you *on* to a hospital birth,
but not sure why it would change your perception of a home birth.

Probably because I felt everything was so calm and planned.If I'm honest,
going in to labour naturally now scares me too. I liked having a date to go
in (by that point I was convinced things weren'y likely to happen on their
own). I liked knowing that all the equipment was there ready for me, and
exactly what was going to happen. I've got that in my head now, and I can't
imagine having a birth elsewhere. It might be that we're moving shortly, so
I'll be in a different house next time, so I guess the lack of visualisation
isn't helping. But no. I think I'm a hospital kinda girl now

I just don't really understand the difference between going to a birth
center and a delivery ward - obviously I understand there aren't the docs
etc there, but when I had Jessica, I recognised the consult on duty, one
I'd seen earlier in my pg and hated, and so refused to have him there. He
didn't interfere after that. Maybe the problem is that more women need to
take greater control and have more say in their labours. I suspect a lot
that choose to birth outside of a hospital already have this ability, and
therefore that could be a factor in their positive birth experiences?

I'm not sure that's true. There is a very different power
structure in one's home versus in a hospital. Someone who can speak
out in an environment where they are in charge is not necessarily
going to speak out in an environment where they're not running the
show. I think many people choose homebirth so they won't *have*
to fight because they know they're not good at that. In addition,
while you spoke up and had your wishes respected, that's not always
the result of speaking up. I think that's the fallacy of the argument
that hospital birth wouldn't have these problems if women would just
get educated and speak up for themselves. The power dynamic inherent
in the situation works against that. It's certainly true that the
woman who is educated and speaks up has a much, much better chance
of getting what she wants in a hospital setting, but there are many
factors operating against her speaking up and against her getting
what she wants even if she does speak up. This, of course, varies
from provider to provider and hospital to hospital.

I can see your points there and they do make a lot of sense to me. However,
I still feel that homebirth/ midwife centre women have often spent a lot of
time researching the options, and have chosen to go against "the norm" and
have clear plans of what they want. Maybe I'm just outspoken, but I always
make my needs and wants clear when I'm in hospital. I think that's why I had
a good birth. I was in control to a certain extent of what I wanted, and
never felt any pressure to have/do anything that I didn't want - i.e., I was
terrified that if the pain got too much, they would try to persuade me to
have relief, such as an epidural, which I am petrified of. I expressed quite
strongly that I was not to be offered it as soon as I got in, and it was
never mentioned. I expressed that I didn't want to give birth on my back,
because of my hips, and even when I was on my side, with my top half off the
bed and on my husband's lap, they never once tried to turn me. I was very
grateful to have had the birth that I wanted. I hadn't done any form of
antenatal class as I wanted to let my body work instinctively, and they went
with that too.

The thing about 1:1 care is the length of labour. If I had had a 27 hour
labour, obviously my midwife would have been replaced at the end of her
shift, probably no matter where i'd been. I'm a fairly easy going person,
and tend to adapt to new people well, but I can understand that would
upset people.

It's not just that it upsets people. It disrupts continuity
of care, which creates more of a potential for information to be
lost and lead to mistakes.

My SIL hired a private midwife. It cost her £2500 to do so, because she
wanted the same midwife throughout. However, there were no guarantees
that she'd have got her midwife at the time of birth. Obviously, the
midwife's job is to be a midwife and to earn money, so she also can not
just have one mother on her books at a time. My SIL was lucky that she
was able to have her midwife there,and I guess it would have upset her if
she hadn't, but even with a homebirth and private midwifery care, nothing
is guaranteed on that front.

No, there's no perfect solution to this problem. However,
there are substantial differences in the odds for different types
of care. Of course, you can always look for the outliers.

I think the domino care system probably works the best, where you get to
know your midwife, and the back up team, so that if you do need a different
midwife before or during labour, you still get one who you know and who
knows you. I'm not sure how common that is here though. I had one community
midwife throughout, and one midwife during labour, plus the odd times with
the the senior. What did annoy me was the consultancy team I was under. I
did often see a different doctor, and felt reassured when I got the one I
liked the most on a few occasions. So I can see why a disruption is a bad
thing, and having to keep repeating yourself isn't nice, but it can be dealt
with. In someways, when they know they're not goig to be with you all the
way through, it encourages them to make more notes on your care ready for
the next person.


The problem is, when you remove the doctor created rules, people sue when
things do go wrong.

?? I don't know about the situation in other countries,
but in the US, midwives get sued at a *dramatically* lower rate
than obstetricians. Not even in the same ballpark. There are
lots of reasons for that, but I'm not sure this argument holds
water in the US.

I can see what you mean about the midwives being sued less, but if something
did go wrong, and these things weren't in place, people would demand to know
why not. I know I would. If there weren't procedures in place to deal with
things, and something happened and people were faffing about wondering what
best next step would be, I would be fuming.

They ask why weren't the rules in place, and what's going to be done
about it. Let's face it, birth is like any other business, and they are
prime targets for legal action. Society as a whole is partly to blame -
how often have people said "oooh, she wants a homebirth. I wouldn't want
that for my first, oh no". A lot of people also view labour as a
medical procedure, so it makes sense for them to go to the hospital. For
others, it's just that it's the norm. Either way, I think that hospital
birth will always be different from a home birth. Even if they give you
your own room designed to look like your own bedroom, you're always going
to know that it's not, and that alone makes a huge psychological
difference. Also, if there's a doctor there to make a decision, then the
midwife will call them - it's the same when I'm at work. I can happily
make decisions when I'm on my own. Bring the teamleader in, and I'm
always after a second opinion. I think that's human nature.

I think this is true, and there are other factors as well.
There have been studies looking at 'home like' environments within
hospitals. They haven't always been well done studies, and they
are often comparing home-like hospital rooms with regular hospital
rooms, rather than home-like hospital rooms with home, but looking
across the studies it still appears that a home-like environment
in the hospital is not the same as at home. That makes a certain
amount of sense to me. Even with a home-like hospital birth, there's
no getting around that the whole decision making process at the
start of labor is different there's a transfer of location. Those
are two big factors that are different right off the bat.

I had to go into hospital a few years ago for a sleep study for my
narcolepsy. They made the room very comfortable, had nice curtains, modern
furniture, to try to promote a good comfortable sleep environment. It was a
great room, but I didn't get a good rest. The fact remained that it was
still a hospital. I'm like that in hotels too. That said, it was a nice
place to be, and probably relaxed me more than if I was in a ward. I didn't
sleep the night before I had Jessica (although I was in labour, it was
silent and so I didn't realise). Part of the problem, aside from the fact I
can't sleep in a hospital, was that wards are busy places. Women were in
labour, one was being sick, one was snoring heavily, midwives were walking
around, greeting the new women, monitoring them etc. On that side, I can see
a plus to a homebirth, but I would still be more comfortable giving birth in
the hospital.

Best wishes,
Ericka

Lucy x

"Welches" wrote in message
...

"Ericka Kammerer" wrote in message
. ..
lucy-lu wrote:
"Anne Rogers" wrote in message
...

Yeah... It was a passing thought really. All the positives I had from a
hosp birth turned me off a home birth.

I think that's an odd way to phrase it ;-) I can see why
a positive hospital birth would turn you *on* to a hospital birth,
but not sure why it would change your perception of a home birth.

I just don't really understand the difference between going to a birth
center and a delivery ward - obviously I understand there aren't the
docs etc there, but when I had Jessica, I recognised the consult on
duty, one I'd seen earlier in my pg and hated, and so refused to have
him there. He didn't interfere after that. Maybe the problem is that
more women need to take greater control and have more say in their
labours. I suspect a lot that choose to birth outside of a hospital
already have this ability, and therefore that could be a factor in their
positive birth experiences?

I'm not sure that's true. There is a very different power
structure in one's home versus in a hospital. Someone who can speak
out in an environment where they are in charge is not necessarily
going to speak out in an environment where they're not running the
show. I think many people choose homebirth so they won't *have*
to fight because they know they're not good at that.
I think what Lucy is saying is that here (the UK) it is generally assumed
that you will go to hospital to have the baby (not so much by the medical
profession, but by general opinion). Someone who decides to have a home
birth will often have a lot of "do you think it's wise" sort of comments.
So (I think) what Lucy is saying is that someone who stays firm and gets a
home birth (particularly for the first birth which is harder to get) is
more likely to stand up generally for themselves wherever they labour.
Correct me if I'm wrong :-)

Nope, you're right

This reluctance for first home births here, does also mean that you get a
number of people who will tell you that they had a dreadful first birth in
hospital and a lovely second birth at home and put it down to being at
home rather than second births being easier (vast generalisation here)
which can mean that a for lot of home v hospital birth stories people
(particularly the older generation)can be very skeptical, and make
comments accordingly.
Debbie
Midwives can also be part of the reluctance. My communirty MW was lovely,
and at the time, I did want a homebirth. As I was clear of GBS, I asked if I
could have a homebirth. She looked horrified! "It's your first birth... What
if there's SD?..." Obviously, as i had to be induced, it wasn;t an issue
anyway, but at the time I felt quite dismayed, any labour suddenly seemed a
very scary & risky business. Maybe that's another factor in me not wanting
homebirths now...

Lucy x

lucy-lu wrote:

I can see your points there and they do make a lot of sense to me. However,
I still feel that homebirth/ midwife centre women have often spent a lot of
time researching the options, and have chosen to go against "the norm" and
have clear plans of what they want. Maybe I'm just outspoken, but I always
make my needs and wants clear when I'm in hospital. I think that's why I had
a good birth. I was in control to a certain extent of what I wanted, and
never felt any pressure to have/do anything that I didn't want - i.e., I was
terrified that if the pain got too much, they would try to persuade me to
have relief, such as an epidural, which I am petrified of. I expressed quite
strongly that I was not to be offered it as soon as I got in, and it was
never mentioned. I expressed that I didn't want to give birth on my back,
because of my hips, and even when I was on my side, with my top half off the
bed and on my husband's lap, they never once tried to turn me. I was very
grateful to have had the birth that I wanted. I hadn't done any form of
antenatal class as I wanted to let my body work instinctively, and they went
with that too.

I think it's wonderful that you had that experience, and
perhaps some of it is due to where you were. Unfortunately, I
think that the statistics in the US largely speak for themselves.
The overwhelming majority of women who go into a hospital birth
saying they want less intervention end up having more intervention
than they said they wanted. The overwhelming majority of women
who have homebirths end up with the level of intervention they
planned for (i.e., very little). This is true even when you
look at first timers who have no reason to know how they'll
react in labor.
Also, it's hard to ignore the number of women who
say they felt like they were unable to speak up for what
they preferred, or who did speak up and were denied what
they asked for. Now, I certainly read and hear mostly about
US births. What is true of US births may not be true of
births elsewhere. But based on everything I've seen, while
there are women who are assertive in labor and who effectively
advocate for what they want, I think it's a minority of women.


No, there's no perfect solution to this problem. However,
there are substantial differences in the odds for different types
of care. Of course, you can always look for the outliers.

I think the domino care system probably works the best, where you get to
know your midwife, and the back up team, so that if you do need a different
midwife before or during labour, you still get one who you know and who
knows you. I'm not sure how common that is here though. I had one community
midwife throughout, and one midwife during labour, plus the odd times with
the the senior. What did annoy me was the consultancy team I was under. I
did often see a different doctor, and felt reassured when I got the one I
liked the most on a few occasions. So I can see why a disruption is a bad
thing, and having to keep repeating yourself isn't nice, but it can be dealt
with.

Again, however, if you look at the rates of medical
mistakes in the US, they're scarily high. Disruptions to
continuity of care are one type of opportunity for these
mistakes to happen. So, it's not that mistakes happen
all that time with standard hospital care, but when a
mistake *does* happen, lack of continuity of care often
turns out to be a factor.

The problem is, when you remove the doctor created rules, people sue when
things do go wrong.
?? I don't know about the situation in other countries,
but in the US, midwives get sued at a *dramatically* lower rate
than obstetricians. Not even in the same ballpark. There are
lots of reasons for that, but I'm not sure this argument holds
water in the US.

I can see what you mean about the midwives being sued less, but if something
did go wrong, and these things weren't in place, people would demand to know
why not. I know I would. If there weren't procedures in place to deal with
things, and something happened and people were faffing about wondering what
best next step would be, I would be fuming.

I'm curious why you think that midwives don't have
procedures and standards of care? They certainly do in the
US. Also, if you look at the stats in the US, *even when there
are bad outcomes*, midwives are substantially less likely to
be sued than OBs. Most researchers attribute this to greater
client involvement in care decisions and a stronger personal
relationship between client and caregiver, though there may
be other factors as well.

Best wishes,
Ericka

I'm curious why you think that midwives don't have
procedures and standards of care? They certainly do in the
US. Also, if you look at the stats in the US, *even when there
are bad outcomes*, midwives are substantially less likely to
be sued than OBs. Most researchers attribute this to greater
client involvement in care decisions and a stronger personal
relationship between client and caregiver, though there may
be other factors as well.

I was confused about this too, but I think I may have started the confusion,
the issue comes when you consider your own personal guideline or standard
and a corporate one, so one very respected midwife I know in the UK has
written her own personal guidelines in many areas, and she will happily show
them to anyone who is interested, but her guideline on twin birth is
completely different to what you might find in a hospital, partly because
there is a large number of twin cases she's not likely to have to deal with,
but there are other huge difference, such her baseline assumption that a
women will be breastfeeding, hence her plan outlines how the mother will be
assisted to suckle twin 1, whilst awaiting twin 2. She's really only
covering twin birth from 36 weeks and is also covering it with all
attendents competant in breech births, something a hospital guideline is
never going to assume, anyway, it's available for all to read, linked from
http://www.marycronkmidwiferyservices.co.uk/, I've not seen a hospital twin
guideline, but I know the kind of thing that is in them, stuff like having
to have an epidural, having to deliver in theatre, all usually with no
research back up (do the epidural and theatre make you more likely to need
theatre?). I'd put money on them also not having the early discussions about
diet and rest and planning for support in case anything goes wrong, that
kind of thing - all of which I would think are likely to improve outcomes.

The problem is, this guideline would only work for a very small group, it
works for Mary and any other midwives she allows to work with her to make up
the team of 3 she has present at a twin birth, it's just not something
that's going to work as soon as the group expected to follow it are any
larger, it also relies on the lead midwife "knowing" the babies, knowing how
they lie in the womb, how they response to monitoring, what there normal
heartrate sounds like etc. also something that doesn't work in a large
practice.

Aus and NZ do have a model where the named midwife pretty much attends
exclusively, I don't understand there system very well, it sounds very good
when it works, but some mutterings I've heard indicate problems, such as
because most of the midwives that attend are not employed by the hospital,
but some midwives and other core staff are, that there can be conflict and
so on. The one midwife I know from down there certainly doesn't seem to view
home and hospital as equal, even though she will have done the same
antenatal care and attend in both locations.

Anne

On May 4, 12:15 am, "lucy-lu" wrote:

I just don't really understand the difference between going to a birth
center and a delivery ward - obviously I understand there aren't the docs
etc there, but when I had Jessica, I recognised the consult on duty, one I'd
seen earlier in my pg and hated, and so refused to have him there. He didn't
interfere after that. Maybe the problem is that more women need to take
greater control and have more say in their labours. I suspect a lot that
choose to birth outside of a hospital already have this ability, and
therefore that could be a factor in their positive birth experiences?

As one who planned a homebirth and had an emergency hospital transfer,
I'd homebirth again in a heartbeat. Frankly, I am quite capable of
exercising my will, but last thing I want to do during labor it have
to fight with my caregivers to conduct my labor as I want.

I was fortunate in that the OB on call was great, and worked well with
my midwife. However the whole environment at the hospital made the
experience *more* stressful, and not because we feared DD was in
danger, at the time we didn't expect much other than she didn't want
to come out on her own. The crowd of nurses I didn't know trying to
stick IVs in me, shouting 'encouragement', etc, was a huge difference
from my calm and relaxed home environment. It wasn't a *bad*
experience, but the atmosphere there was indeed stressful because the
staff made it so. If it wasn't for the OB keeping her calm and my
midwife staying in control, I probably would have panicked.

The thing about 1:1 care is the length of labour. If I had had a 27 hour
labour, obviously my midwife would have been replaced at the end of her
shift, probably no matter where i'd been. I'm a fairly easy going person,
and tend to adapt to new people well, but I can understand that would upset
people. My point is, that in a lot of cases, you're not going to get the
same midwife taking care of your needs, even when you're lucky enough (as I
was) to have been the only labouring mother the midwife has at the time. You
might give birth an hour after shift change, but that midwife won't have
been there all the way through, getting to know you and your needs.

My SIL hired a private midwife. It cost her £2500 to do so, because she
wanted the same midwife throughout. However, there were no guarantees that
she'd have got her midwife at the time of birth. Obviously, the midwife's
job is to be a midwife and to earn money, so she also can not just have one
mother on her books at a time. My SIL was lucky that she was able to have
her midwife there,and I guess it would have upset her if she hadn't, but
even with a homebirth and private midwifery care, nothing is guaranteed on
that front.

Slight difference then in the US - well it can vary in the US too - I
hired ONE midwife, not a team. She comes with assistant midwives
(there are a number in this area and they will act as assistants to
the primary midwife, sharing duties). So my midwife was with me
throughout.

Recovery was also a big issue. A hospital is the _least_ restful place
imagineable! The nurses came in every 3 hours for vitals, coming in at
2am all chatty making me wide awake instead of quietly taking the
signs and walking out. I couldn't fall back to sleep. During the day
we had the OB (and the residents and students), the LC - whom I
wanted, assorted nurses, the social worker, the chaplain, the
insurance person, the person who did the birth certificate....each
coming in multiple times. Now, since DD was in NICU I was glad
initially I only had to walk upstairs to see her, but by the 3rd day
we were desperate to get out (I lived close enough that going in to
see her was not a huge hassle). And then there was the food! Despite
filling out the menu card for healthy foods (I could barely eat, but
wanted non-meat items and things like soup), they kept bringing up
burgers+chips!! I was shocked they even served such food. And this
wasn't a _bad_ hospital. I work with them and respect this hospital,
it's just the whole environment of it is not conducive to rest.

Lucy wrote:
My SIL hired a private midwife. It cost her £2500 to do so, because she
wanted the same midwife throughout. However, there were no guarantees that
she'd have got her midwife at the time of birth. Obviously, the midwife's
job is to be a midwife and to earn money, so she also can not just have
one
mother on her books at a time. My SIL was lucky that she was able to have
her midwife there,and I guess it would have upset her if she hadn't, but
even with a homebirth and private midwifery care, nothing is guaranteed on
that front.

cjra replied:
Slight difference then in the US - well it can vary in the US too - I
hired ONE midwife, not a team. She comes with assistant midwives
(there are a number in this area and they will act as assistants to
the primary midwife, sharing duties). So my midwife was with me
throughout.

I don't know if Lucy's SIL had a different system to what is common in the
UK, but if you do hire an Independent midwife, they do only take women on at
a rate that they have a jolly good chance of making the birth, 2-3 women a
month is not uncommon, of course you could get unlucky and go into labour at
exactly the same time as another women, but on those numbers it is unlikely.
There may be some working as larger groups in central London, but I'm not
aware of any, because of the NHS system, independent midwifes are less
common than midwives that work in a similar way in the US, so large towns
may only have one, but most are prepared to travel. I've never yet come
across a story of someone booked with an independent midwife where that
particular IM is not present at the birth. From what I can tell, independent
midwifery works out for the mother-to-be very much like midwifery in the US
does, with similar problems should a hospital transfer occur as they often
aren't recognised as practioners at the hospital and it's up to each
individual to work very hard at having good relations with local staff.

Anne